The objective of this study is to review the sedation combinations used in our intensive care unit (ICU) for pediatric bronchoscopic procedures. Sixty-four patients from ages 1 to 18 years were identified from the ICU database as having undergone fiberoptic bronchoscopy with bronchoalveolar lavage or transbronchial biopsy between June 1991 and December 1995. A retrospective chart review was performed on those patients. The dosages of medications used for sedation were noted and a mg/kg dose was calculated. Also noted were the procedure duration and complications including oxygen desaturation, bradycardia, and neuropsychologic complications. A total of 103 bronchoscopies were performed in 64 patients. Ketamine and midazolam were used in 42 procedures, while fentanyl and midazolam were used in 38. The remaining 23 procedures used other drug combinations. Seventy percent of the ketamine group received atropine pre-procedure as an antisialogue. Major complications were found in 13 patients, including oxygen desatur-ation, stridor, cough, and nasal bleeding. Twelve of the 13 complications occurred in patients treated with ketamine in combination with another agent. Twelve of the 13 complications were in patients with human immunodeficiency virus disease. Eight of the 13 complications involved children 3 years old or younger. Ketamine has been a useful drug for analgesia in pediatric procedures for many years. However, pediatric bronchoscopy, by virtue of its invasiveness on the pediatric airway and its impact on an already compromised lung, may be an exception to the safety profile of ketamine. Its use, especially in the smaller airway, may need to be reconsidered and should be evaluated prospectively. A manuscript has been accepted for publication in Chest.